Managing an out-of-hours service is all about ensuring you listen to patients and doctors, and establish good information flow with other services, argues Dr Paul Zollinger-Read

I am privileged to work both as a GP and as a manager (CEO of a PCT). Some of you may not see it as a privilege, but believe me, good management is as crucial to patient care as Occam's razor to the physician.

One of the most important steps in setting up or commissioning an out-of-hours service is making sure that the lines of communication are open. It is crucial to listen to patients' views and also to involve local clinicians to help shape the type of service we want.

Once my PCT had awarded the contract for the out-of-hours service, it was vital

to set up forums where local GPs could meet with the provider to discuss important local issues. These channels of communication are essential and have ensured that we have continual feedback on our service.

One of the important issues to arise was the need to improve information flow between surgeries and the out-of-hours provider, particularly in relation to very high-intensity users and patients requiring end-of-life care. This was achieved by developing a special patient register and keeping it updated. We also ensured that the provider was contractually obliged to provide information back to surgeries in a clearly agreed format.

Also important is the issue of anticipatory prescribing, through the gold standard framework for end-of-life care and the Liverpool care pathway. Anticipatory prescribing ensures out-of-hours care is consistent and that everyone is aware of what GP care has been prescribed. This helps to ensure that the patient will get the right care and not end up in hospital.

Has this worked for us? Yes. Clinical feedback into our regular contracting meetings has helped us to hold the provider to account for agreed outcomes – and it has certainly risen to the challenge.

Dr Paul Zollinger-Read is chief executive of North East Essex PCT

Clinical feedback into our regular contracting meetings has helped us to hold the provider to account for agreed outcomes. Dr Paul Zollinger-Read